VA/DOD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE - VA/DOD CLINICAL PRACTICE GUIDELINES
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VA/DoD CLINICAL PRACTICE GUIDELINE FOR
THE MANAGEMENT OF CHRONIC
OBSTRUCTIVE PULMONARY DISEASE
Department of Veterans Affairs
Department of Defense
Patient Summary
I. What is Chronic Obstructive Pulmonary Disease?
Chronic obstructive pulmonary disease, or COPD, is a combination of ongoing conditions that affect your
lungs and obstruct or block airflow from the lungs. These conditions can include chronic bronchitis and
emphysema.
COPD can be prevented and treated. It can be recognized by its key characteristic: shortness of breath or
difficulty breathing, especially when exhaling or breathing out. However, if you have COPD, you could have
other symptoms such as chest pressure, chronic cough, mucus, and wheezing.
Did You Know?
· Veterans are at higher risk of COPD than those in the general U.S. population.(1)
· Some military duties or activities may increase risks for COPD.
· Military physical activity may uncover symptoms of COPD. Active duty military or Veterans may
show signs of COPD earlier than their civilian counterparts.(2)
II. What Causes COPD?
People get COPD for different reasons. The most common cause is tobacco use – particularly cigarette
smoking. However, long periods of exposure to substances that irritate the lungs can also cause COPD. The
irritating substances could be gases, chemicals, or particles that are part of the work or home
environment. This exposure can cause portions of the lungs to stop working as they should.
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VA/DoD CPG for the Management of Chronic Obstructive Pulmonary Disease – Patient Summary
Figure 1: Images of healthy lungs and lungs affected by COPD (3)
III. How is COPD Diagnosed?
Your provider (which may be a doctor, physician assistant, or nurse practitioner) can explain the symptoms
and tests that determine if you have COPD. If your provider suspects you may have COPD, he or she can
arrange for a simple breathing test to determine whether you do or do not have the disease.
IV. What are the Goals of COPD Treatment?
The overall goal of treating your COPD is to control the symptoms and optimize your health for better
quality of life and mental health. Well-treated COPD will allow you to be more physically active and may
improve your sleep.
Goals of COPD Treatment
· Prevent COPD from getting worse
· Improve symptoms:
¨ Decrease shortness of breath
¨ Help you to perform social activities, physical activities, and exercise
¨ Improve your quality of life and your mental health
· Treat and prevent:
¨ Exacerbations (when COPD symptoms suddenly worsen)
¨ Complications
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VA/DoD CPG for the Management of Chronic Obstructive Pulmonary Disease – Patient Summary
V. What are the Options for COPD Treatment?
There are many treatment options for COPD that can help you reach your goals. By talking with your
provider, you can learn more about the available treatment options and how they can help you. Work with
your provider to find treatments that improve your symptoms and your health. The following treatment
options are things that your provider may ask you to do at home or to make a part of your normal routine.
VI. Medication
Your provider may prescribe medication that you breathe in or inhale straight to your lungs. The
medication can help you keep your symptoms from worsening or help manage your COPD. With
instructions and practice, the inhaled medication can be easy to use. Work with your provider to make
sure that you are taking the inhaled medication correctly and as directed. There are many different types
of inhaled medications. These medications work in different ways and affect different parts of the lungs to
help improve your breathing. Do not be afraid to ask questions or ask for help.
Inhaled medications work for different lengths of time depending on the medication type (short-acting or
long-acting).
· Short-acting medications work within a few minutes. Your provider will explain how to use these
medications when you are experiencing symptoms that are worse than usual.
· Long-acting medications help control your COPD symptoms so they do not worsen. You should
take long-acting medications even if you feel fine and your symptoms are no worse than usual.
More information on types of medications can be found in Table 1.
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VA/DoD CPG for the Management of Chronic Obstructive Pulmonary Disease – Patient Summary
Table 1: Types of Inhaled Medications Used to Treat COPD
Examples of the Types and
Medications Abbreviations How It Works How Long It Works
Ventolin Short-acting · RESCUE for sudden change of symptoms Works in 1-5 minutes;
Proventil ProAir (SABA) · Short-lasting treatment to relax and open small lasts 3-6 hours
Xopenex airways for fast relief
Foradil Long-acting · MAINTENANCE – use even without change in Works in 20 minutes;
Serevent (LABA) symptoms lasts 12 hours
· Long-lasting treatment to relax and open large
airways (will not provide fast relief)
Atrovent Short-acting · MAINTENANCE – use even without change in Works in 15 minutes;
(SAMA) symptoms lasts 6-8 hours
· Short-lasting treatment to relax and open large
airways (will not provide fast relief)
Spiriva Long-acting · MAINTENANCE – use even without change in Works in 20 minutes;
(LAMA) symptoms lasts 24 hours
· Long-lasting treatment to relax and open large
airways (will not provide fast relief)
Qvar Long-acting · MAINTENANCE – use even without change in Works in few days or
Flovent (ICS) symptoms few weeks when
· Long-lasting treatment to reduce and prevent taken regularly
airways swelling (will not provide fast relief); you
may have less coughing or wheezing
These medications are inhaled by mouth. There are other medications to treat COPD, such as theophylline,
roflumilast, and chronic macrolides. Your provider may prescribe one of these after consulting with a
pulmonologist, a doctor who treats diseases of the lungs.
Some breathing medications are delivered with a device called a metered-dose inhaler. See Figure 1 and
Figure 2 for step-by-step guides on how to use a metered dose inhaler.(4) Other breathing medications
may be delivered from devices called Diskus, Twisthaler, or Respimat. Your provider can show you how to
use the devices and give you handouts with instructions.
April 2021 Page 4 of 8VA/DoD CPG for the Management of Chronic Obstructive Pulmonary Disease – Patient Summary Figure 1: Using Your Metered Dose Inhaler Figure 2: Using Your Metered Dose Inhaler WITH a Mouthpiece Spacer/Chamber WITHOUT a Spacer/Chamber April 2021 Page 5 of 8
VA/DoD CPG for the Management of Chronic Obstructive Pulmonary Disease – Patient Summary
VII. Other Treatment Options
Your provider may discuss other forms of treatment with you. These may include:
· Oxygen therapy
· Supported self-management (working with a case manager and/or a pulmonary rehabilitation
program to help you manage your COPD and reduce symptoms)
· Telehealth monitoring
· Breathing retraining
· Nutrition education
· Surgery
VIII. What Should You Do If Your COPD Worsens?
A COPD exacerbation is a sudden worsening in your ability to breathe or more shortness of breath with
increased cough and change in mucus or phlegm amount and/or color. If you think you are having a COPD
exacerbation, you should get medical help right away from the clinic or emergency department. Your
provider will work with you to establish an action plan before starting any stand-by medications.
IX. What Else Can You Do to Improve Your Health?
· Quit smoking and avoid secondhand smoke. Quitting smoking and avoiding any respiratory
irritants like secondhand smoke can save your lung function and slow the progress of COPD more
than any medical treatment available. This is the most important of all COPD treatments. Ask your
provider about tools that can help you quit smoking. Resources are also available at
http://smokefree.gov/.
· Get vaccinated. Illnesses such as a cold or the flu impact people with COPD more than others.
Make sure to get the flu shot every year. The pneumonia vaccines are also important in reducing
complications to COPD. Talk to your provider about the vaccines and when to get them.
X. Questions to Ask Your Provider
· How is my COPD diagnosis confirmed?
· How is my COPD progressing compared to an average COPD patient?
· Am I taking my medication the right way? (Take your inhalers to your appointments and have your
provider, clinical pharmacist, or respiratory therapist show you how to use them.)
· Should I take any of my medications all the time?
· What medication should I take when my symptoms are worse than usual?
· When should I go to the emergency department?
· How much activity should I have in my everyday life?
· Are there any special exercises I should be doing?
· Should I change my diet?
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XI. Frequently Asked Questions
· If I quit smoking, will it really help my COPD?
Yes, the single best thing you can do to prevent your COPD from getting worse is to stop smoking.
Ask your provider how he or she can help you stop smoking. You should also avoid places where
other people are smoking. This will help you avoid breathing in secondhand smoke.
· Is it safe to be around my family and friends?
Yes, you should stay active and do things with your family and friends. COPD is not contagious, and
you may feel better after spending time with loved ones. However, you should avoid being around
them when they are smoking. You should also avoid contact with anyone that has a cold, a cough,
or the flu symptoms. People with COPD are more likely to have serious complications when they
catch the cold or flu virus.
· Is it safe for me to receive the flu vaccine and other vaccines that my provider recommends?
Yes, it is safe for you to receive these vaccines. You can reduce risks for respiratory infections and
COPD complications by getting the flu vaccine every year and other vaccines that your provider
recommends.
· My doctor said the breathing test showed that I only have small percent of lung function. What
does that mean?
The breathing test to confirm your diagnosis of COPD can also tell how much your exhaled airflow
is limited.
· I take all the medications – why do I still get short of breath doing any little thing?
Getting short of breath depends on how severe your COPD is, if you have any heart condition, and
how well your muscles work. If you are still short of breath while taking all your medications, talk
with your provider. Undergoing physical rehabilitation or pulmonary rehabilitation will improve
your ability to function. Ask your provider to see which program you need and can qualify for.
· My walk test showed my oxygen was above 90% – why am I still short of breath?
Although low oxygen can contribute to shortness of breath, problems with airways in COPD can
also make you short of breath. When the airways are narrow, the lungs cannot ventilate or move
air adequately. Ventilation is needed to be able to move oxygen in and move used air or carbon
dioxide out. Lack of good lung ventilation in COPD makes you short of breath. Use of inhaled
medication can improve ventilation and reduce your shortness of breath. Increase physical
function from rehabilitation can also reduce your shortness of breath.
XII. You Can Find More Information on COPD and Living with COPD Here:
· National Heart Lung and Blood Institute: http://www.nhlbi.nih.gov/health/health-
topics/topics/copd/; 301-592-8573 (dial 7-1-1 for access to free Telecommunications Relay
Services [TRS])
· U.S. Centers for Disease Control and Prevention: http://www.cdc.gov/copd/; 800-CDC-INFO (800-
232-4636); TTY: (888) 232-6348
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XIII. References
1. Joseph Finkelstein EC. Association of veteran status with COPD prevalence stratified by gender.
American journal of respiratory and critical care medicine. 2013;187.
2. Morris MJ, Lucero PF, Zanders TB, Zacher LL. Diagnosis and management of chronic lung disease in
deployed military personnel. Ther Adv Respir Dis. 2013;7(4):235-45. Epub 2013/03/09.
doi: 10.1177/1753465813481022. PubMed PMID: 23470637.
3. The University of Chicago. COPD [cited 2021 April 13]. Available from:
http://asthma.bsd.uchicago.edu/sample-page/chronic-obstructive-pulmonary-lung-disease-copd/.
4. VA Palo Alto Health Care System, U.S. Department of Veterans Affairs. Inhalers and pulmonary
medications - patient education [cited 2021 April 13]. Available from:
https://www.paloalto.va.gov/services/pulmonary/res_inhalers.asp.
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